Predictors of 30-Day Readmission After Subarachnoid Hemorrhage

Singh, Mandeep; Guth, James; Liotta, Eric M.; Kosteva, Adam; Bauer, Rebecca; Prabhakaran, Shyam; Rosenberg, Neil; Bendok, Bernard R.; Maas, Matthew B.; Naidech, Andrew M.

doi:10.1007/s12028-013-9908-0

Cited by 40 publications

(29 citation statements)

References 20 publications

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“…Although several studies have attempted to identify risk factors for readmission, such efforts alone are insufficient to understand the utility of rehospitalization as a quality metric and to identify targets for improved patient care. 20,28 To complement these quantitative approaches, qualitative analyses have been used for a variety of conditions to identify the causes underling readmission, including potential lapses in care and unavoidable disease progression. 9,22,25,33 In this study, we qualitatively analyzed the unique factors leading to rehospitalization after aneurysmal SAH.…”

Section: Discussionmentioning

confidence: 99%

“…29 Although 30-day readmission has begun to be used as a quality marker in SAH research, 19 most studies investigating readmission in stroke patients have focused on ischemic etiologies, and, therefore, evidence describing the causes underlying rehospitalization after SAH is lacking. 6,20,21,30 While small-scale efforts have been made to identify predictors of readmission after SAH, 28 the reasons for readmission, including both medical/surgical diagnoses and underlying root causes, remain unknown. Stakeholders need such information to determine the extent to which readmission reflects deficiencies in clinical care and subsequently plan quality improvement initiatives to address potential shortcomings.…”

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confidence: 99%

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Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage

Greenberg¹,

Washington²,

Guniganti³

et al. 2016

JNS

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OBJECTIVE Hospital readmission is a common but controversial quality measure increasingly used to influence hospital compensation in the US. The objective of this study was to evaluate the causes for 30-day hospital readmission following aneurysmal subarachnoid hemorrhage (SAH) to determine the appropriateness of this performance metric and to identify potential avenues for improved patient care. METHODS The authors retrospectively reviewed the medical records of all patients who received surgical or endovascular treatment for aneurysmal SAH at Barnes-Jewish Hospital between 2003 and 2013. Two senior faculty identified by consensus the primary medical/surgical diagnosis associated with readmission as well as the underlying causes of rehospitalization. RESULTS Among 778 patients treated for aneurysmal SAH, 89 experienced a total of 97 readmission events, yielding a readmission rate of 11.4%. The median time from discharge to readmission was 9 days (interquartile range 3–17.5 days). Actual hydrocephalus or potential concern for hydrocephalus (e.g., headache) was the most frequent diagnosis (26/97, 26.8%), followed by infections (e.g., wound infection [5/97, 5.2%], urinary tract infection [3/97, 3.1%], and pneumonia [3/97, 3.1%]) and thromboembolic events (8/97, 8.2%). In most cases (75/97, 77.3%), we did not identify any treatment lapses contributing to readmission. The most common underlying causes for readmission were unavoidable development of SAH-related pathology (e.g., hydrocephalus; 36/97, 37.1%) and complications related to neurological impairment and immobility (e.g., thromboembolic event despite high-dose chemoprophylaxis; 21/97, 21.6%). The authors determined that 22/97 (22.7%) of the readmissions were likely preventable with alternative management. In these cases, insufficient outpatient medical care (for example, for hyponatremia; 16/97, 16.5%) was the most common shortcoming. CONCLUSIONS Most readmissions after aneurysmal SAH relate to late consequences of hemorrhage, such as hydrocephalus, or medical complications secondary to severe neurological injury. Although a minority of readmissions may potentially be avoided with closer medical follow-up in the transitional care environment, readmission after SAH is an insensitive and likely inappropriate hospital performance metric.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage

Greenberg¹,

Washington²,

Guniganti³

et al. 2016

JNS

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“…In another study, 2 among patients with no angiographic evidence of SAH, 75% experienced severe headache during their inpatient stay, and 25% experienced persistent headache at a mean follow-up of more than 24 months after discharge. The results of a prospective study 14 published in 2013 indicated that headache was the second-leading cause for 30-day hospital readmission after SAH. Long-term follow-up data indicate that headache may persist after SAH for 2 to 9 years.…”

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confidence: 99%

Inadequacy of Headache Management After Subarachnoid Hemorrhage

Glisic

Gardiner

Josti

et al. 2016

American Journal of Critical Care

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“…Prior analyses are limited by focusing on patient‐level characteristics and in‐patient mortality . A single‐center study found most readmissions after aSAH were related to infections or symptomatic hydrocephalus . A population‐based study found no difference in mortality or readmission rates between clipping and endovascular coiling among older patients with aSAH .…”

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confidence: 99%

“…There is only limited understanding of the hospital-level determinants of 30-day readmission and mortality after aSAH among older patients. Prior analyses are limited by focusing on patient-level characteristics [7][8][9] and in-patient mortality. [10][11][12] A single-center study found most readmissions after aSAH were related to infections or symptomatic hydrocephalus.…”

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confidence: 99%

Advanced Age and Post–Acute Care Outcomes After Subarachnoid Hemorrhage

Fehnel

Gormley

Dasenbrock

et al. 2017

JAHA

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BackgroundOlder patients with aneurysmal subarachnoid hemorrhage (aSAH) are unique, and determinants of post–acute care outcomes are not well elucidated. The primary objective was to identify hospital characteristics associated with 30‐day readmission and mortality rates after hospital discharge among older patients with aSAH.Methods and ResultsThis cohort study used Medicare patients ≥65 years discharged from US hospitals from January 1, 2008, to November 30, 2010, after aSAH. Medicare data were linked to American Hospital Association data to describe characteristics of hospitals treating these patients. Using multivariable logistic regression to adjust for patient characteristics, hospital factors associated with (1) hospital readmission and (2) mortality within 30 days after discharge were identified. A total of 5515 patients ≥65 years underwent surgical repair for aSAH in 431 hospitals. Readmission rate was 17%, and 8.5% of patients died within 30 days of discharge. In multivariable analyses, patients treated in hospitals with lower annualized aSAH volumes were more likely to be readmitted 30 days after discharge (lowest versus highest quintile, 1–2 versus 16–30 cases; adjusted odds ratio, 2.10; 95% confidence interval, 1.56–2.84). Patients treated in hospitals with lower annualized aSAH volumes (lowest versus highest quintile: adjusted odds ratio, 1.52; 95% confidence interval, 1.05–2.19) had a greater likelihood of dying 30 days after discharge.ConclusionsOlder patients with aSAH discharged from hospitals treating lower volumes of such cases are at greater risk of readmission and dying within 30 days. These findings may guide clinician referrals, practice guidelines, and regulatory policies influencing which hospitals should care for older patients with aSAH.

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Predictors of 30-Day Readmission After Subarachnoid Hemorrhage

Cited by 40 publications

References 20 publications

Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage

Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage

Inadequacy of Headache Management After Subarachnoid Hemorrhage

Advanced Age and Post–Acute Care Outcomes After Subarachnoid Hemorrhage

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